Citation and License

Arthritis Research & Therapy 2012, 14:R174
doi:10.1186/ar3927

Published: 27 July 2012

Abstract

Introduction

Identification of patients who are in early stages of lupus is currently done through
clinical evaluation and is not greatly facilitated by available diagnostic tests.
Profiling for patient characteristics and antibody specificities that predict disease
would enhance the ability of physicians to identify and treat early cases prior to
onset of organ damaging illness.

Methods

A group of 22 patients with 4 or fewer diagnostic criteria for lupus were studied
for changes in clinical and autoantibody profiles after a mean follow up period of
2.4 years. An array with more than 80 autoantigens was used to profile immunoglobulin
G (IgG) and immunoglobulin M (IgM) autoantibodies. Correlations with clinical disease
progression were examined.

Results

3 of the 22 patients (14%) added sufficient criteria during follow up to satisfy a
diagnosis of systemic lupus erythematosus (SLE) or to acquire a diagnosis of SLE renal
disease. Patients who progressed were all females and were younger than those who
did not progress (P=0.00054). IgG but not IgM autoreactivity showed greater increases in the progressor
group than in the non-progressor group (P=0.047). IgG specificities that were higher at baseline in progressors included proliferating
cell nuclear antigen (PCNA), beta 2 microglobulin, C1q and hemocyanin (P<0.019). Progressors had significant increases in La/SSB and liver cytosol type 1
(LC1) IgG autoantibodies over the period of evaluation (P≤0.0072). A quantitative risk profile generated from baseline demographic and autoantibody
variables yielded highly different scores for the progressor and non-progressor groups
(P=1.38 × 10-7)

Conclusions

In addition to demographic features, autoantibody profiles using an expanded array
of specificities were correlated with the risk of progressive disease in patients
with lupus. These findings suggest the feasibility of developing a simple diagnostic
that could be applied by nonspecialists to screen for lupus and permit effective triage
for specialty care.